Community-wide cardiovascular disease prevention in young people: Long-term outcomes of the Class of 1989 Study

The Class of 1989 Study, as part of the Minnesota Heart HealthProgram, examines 2 cohorts of adolescents in 2 communitiesin northcentral US. The goal of the study was to reduce therisk of cardiovascular disease among young people in one ofthe cohorts through changes in smoking, eating patterns andphysical activity levels. Because of its importance as a healthbehaviour, alcohol use was also addressed, even though it wasnot a specific target of the Minnesota Heart Health Program.The behaviour patterns of both cohorts were surveyed annuallyin schools from 1983 to 1989. One cohort additionally was exposedto 5 years of behavioural health education in their schools,peer leadership and a community-wide programme for adults. Thebehaviour health education curricula focused on skills, competencies,role models and norms for healthier behaviour. Students in theeducated cohort demonstrated significant reductions in smokingfrom 1984 to 1989. Females in the educated cohort also consistentlyreported significantly healthier eating habits and physicalactivity patterns than the reference cohort. Short-term changesin alcohol use were also noted among both males and females,consistent with the results of other research studies of school-basedprogrammes. Results for eating patterns and physical activitypatterns with males were not as robust as with females. Nevertheless,behavioural health programmes in schools coordinated with community-wideeducation and campaigns with adults appears promising.     

Role of policosanols in the prevention and treatment of cardiovascular disease

Policosanols are a mixture of aliphatic alcohols derived from purified sugar cane. When administered at 5 to 20 mg/day, policosanols have been shown to decrease the risk of atheroma formation by reducing platelet aggregation, endothelial damage, and foam cell formation in animals. Additionally, policosanols have been shown to lower total and low-density lipoprotein (LDL) cholesterol levels by 13 to 23% and 19 to 31%, respectively, while increasing high-density lipoprotein (HDL) cholesterol from 8 to 29%. Policosanols are thought to improve lipid profiles by reducing hepatic cholesterol biosynthesis while enhancing LDL clearance. When compared with statins, policosanols exhibit comparable cholesterol-lowering effects at much smaller doses. The mixture is well tolerated when administered to animals; however, a more precise safety profile is needed for humans. In summary, policosanols are a promising resource in the prevention and therapy of cardiovascular disease (CVD), but these results need to be confirmed in independent laboratories.     

Changes in cardiovascular risk factors among adolescents from 1995 to 2004 in the Republic of Karelia, Russia

BACKGROUND: In Russia, cardiovascular mortality is among the highest in the world. Behaviours related to the development of cardiovascular disease are usually adopted in childhood and adolescence. Very little information exists on prevalence and trends of risk factors among Russian youth. This study aims to investigate changes in the prevalence of cardiovascular risk factors among adolescents in the Republic of Karelia, Russia, from 1995 to 2004. METHODS: Cross-sectional surveys on chronic disease risk factors were carried out among 15-year-old adolescents in Pitk?ranta region, in the Republic of Karelia. The surveys were conducted in all 10 secondary schools in the Pitk?ranta region. All ninth-grade students in 1995 (N = 385, response rate 95%) and in 2004 (N = 395, response rate 85%) were included in the survey samples. RESULTS: Systolic blood pressure decreased statistically significantly among boys (from 119 to 116 mmHg). Diastolic blood pressure decreased statistically significantly among both girls (from 64 to 59 mmHg) and boys (from 62 to 59 mmHg). Total cholesterol increased statistically significantly only among girls (from 3.9 to 4.1 mmol/l). Body mass index did not exhibit any significant changes in both genders. Daily smoking rate doubled statistically significantly among girls from 7% to 15%. CONCLUSION: The study results show changes in the prevalence of cardiovascular disease risk factors among adolescents in the Republic of Karelia occurring over the last decade. Active measures need to be taken to prevent the increase in smoking prevalence, especially among girls, and to avert the unfavourable development of other risk factors in the future.     

蒙古族人群胰岛素抵抗与心血管病关系

目的 探讨蒙古族人群中胰岛素抵抗与心血管病危险因素水平及其聚集性的关系。方法 对1 090名蒙古族成年人进行血压、身高、体重、腰围及臀围的测量和血糖、胰岛素、血脂的检测。按照胰岛素抵抗指数水平由低到高将全部研究对象等分为4组,比较4组间各危险因素及其聚集性差异。结果 调整年龄、性别因素后,体质指数、腰臀比、收缩压、舒张压、甘油三酯、空腹血糖及高血压患病率均随着胰岛素抵抗指数的水平增高而上升(P<0.05)。在调整年龄和体质指数后,胰岛素抵抗指数与腰臀比、收缩压、甘油三酯呈显著正相关。具有≥2个危险因素的个体所占百分比随着胰岛素抵抗指数增高而增高,在4组的比例分别为33.8%,44.5%,47.2%和66.5%(χ²=60.265 7,P<0.000 1)。结论 胰岛素抵抗与多种心血管病危险因素具有相关性,并影响多种心血管病危险因素水平,增加其聚集强度。     

健康查体人群心脑血管病危险因素调查

目的 掌握所属人员身体状况，减少心脑血管病发生。方法 利用3年健康体检资料和门诊随访进行心脑血管疾病高危因素和治疗依从性等调查。结果 患高血压、高血脂、脂肪肝的人员逐年增加且患病人员的治疗依从性较差，其中包括医务人员。结论生活方式病的预防和掌握自我保健知识的工作已刻不容缓。     

Medicalisation,risk and the use of statins for primary prevention of cardiovascular disease: a scoping review of the literature

Primary prevention of cardiovascular disease has been a site of medicalisation, as demonstrated by the significant increase in the use of cholesterol-lowering drugs, statins, over the last thirty years. While this is welcomed by many in the medical community, others have criticised the expansion of statin use to low-risk people. In the context of this debate, the aim of this article is to present a broad scoping review of the literature on how preventative health, risk and ‘candidacy’ for statin treatment are perceived and negotiated by clinicians and patients. We examine how evidence and knowledge about cardiovascular risk reduction is produced, interpreted and communicated and how patients’ gender, socio-demographic and cultural differences may impact patterns of statin use. We found that few studies differentiated between the use of statins in those with and those without established cardiovascular disease, despite the fact that the majority of statin users, and women in particular, fall into the primary prevention category. In this context, the process of medicalisation is predicated on healthy individuals being subject to medical surveillance of risk factors, which have acquired the status of disease in their own right. Central to this process has been the heuristic that identifies elevated cholesterol as a medical problem warranting statin treatment, as well as the difficulties encountered by doctors and patients in understanding, interpreting and communicating risk. This individualised construction of risk and disease has largely ignored the supposedly widely recognised social and political determinants of health and illness.     

Determination of dietary habits as a risk factor of cardiovascular heart disease in Turkish adolescents

Summary Background To investigate dietary habits and evaluate these with regard to cardiovascular risk status in Turkish adolescents aged 12–19 years. Methods A total of 300 adolescents, 135 males and 165 females aged between 12 and 19, were included in the study. Dietary intake was determined by using 3–day food records (including 1 weekend day). Adolescents smoking habits and familial chronic diseases were recorded. The values obtained for energy and nutrient intakes were compared with RDA and DRI and recommendations given by AHA. Results The mean energy intakes of male and female subjects were 1964 ± 723 kcal and 1804 ± 486 kcal respectively. According to NHANES III, age–standardized (CDC: Centers for Disease Control and Prevention) prevalence of overweight indicated that 20.7% among male and 17.5% among female adolescents were at risk for becoming overweight. The prevalence of premature CHD family history was found to be 9.6% for males and 11.5 % for females. The prevalence of current smoking was found to be 22.2 % for males and 18.2 % for females. In addition, 29.6% of the males and 37.6% of the females were physically inactive (p < 0.05); however, male adolescents (48.2%) were significantly more likely than female adolescents (52.1 %) to report sufficient moderate physical activity (p < 0.05). The dietary fiber intake was slightly below the recommended intake of 10 g per 1000 kcal. Compared to the AHA averages, these adolescents had significantly higher intake of total fat, saturated fat, sodium and dietary cholesterol and lower intake of polyunsaturated fat, monounsaturated fat and dietary fiber. The Turkish adolescents also had higher amounts of energy from fat. The mean percentage of energy from fat was 34.2 ± 6% TE for males and 35.2 ± 6.8 % TE for females; saturated fat was 11.8 ± 6.8 % TE for males and 12.1 ± 8.9 for females. The intake of fat and saturated fat was higher than the AHA recommendations. The polyunsaturated to saturated fat ratio was 0.4 ± 0.2 and reflected a high saturated fat (12.0 ± 7.7% TE) and low polyunsaturated fat (5.5 ± 3.9 % TE) diet. In addition, the percentage of adolescents who did not meet 66% of RDA for vitamin E, B6, and folates and the recommendation for RDA dietary fiber is presented. Approximately, 80% of adolescents failed to meet the dietary recommendation of the AHA for polyunsaturated fatty acids, and about 26.7% reported a cholesterol intake higher than 100 mg/1000 kcal. Conclusion It can be said that fiber, total fat, saturated fatty acid, cholesterol and sodium intake of Turkish adolescents are found to be high; however, their vitamin E, vitamin B6 and folate intake are found to be low compared to AHA recommendations. Turkish adolescents fruit and vegetable intake are also found to be low.     

《中国心血管病报告2016》概要

  目的  了解2013年上海市35～59岁人群缺血性心血管病（ICVD）相关危险因素,并对其10年发病风险进行评估。  方法  使用2013年上海市慢性病及其危险监测数据进行分析,选取35～59岁人群作为研究对象。运用“国人ICVD10年发病危险度评估方法”根据各危险因素的得分之和求得个体10年ICVD发病的绝对危险度;并根据绝对危险度对发病危险进行分级。  结果  上海市35～59岁人群缺血性心血管事件10年发病绝对危险度为3.19 %(95 % CI = 3.11 %～3.27 %),其中男性 (4.16 %,95 % CI = 4.00 %～4.32 %)高于女性(2.58 %,95 % CI = 2.50 %～2.67 %);发病绝对危险度随着年龄增加而上升,城市地区、城乡结合部、农村地区发病绝对危险度不同。35～59岁人群中ICVD10年发病风险高危者、中危者、低危者分别占5.38 %、13.35 %、81.27 %。不同性别、不同年龄间危险分级分布不同;无论对于男性还是女性,随着年龄增长发病风险高危者比例逐渐升高。不同地区间ICVD10年发病危险分级分布不同。  结论  上海市35～59岁人群中不同性别、不同年龄段平均危险度均高于评估方法的参考标准,ICVD10年发病风险高危者占5.38 %,应采取综合措施预防心血管疾病的发生。     

Vitamin D and cardiovascular disease

Vitamin D insufficiency/deficiency has been observed worldwide at all stages of life. It has been characterized as a public health problem, since low concentrations of this vitamin have been linked to the pathogenesis of several chronic diseases. Several studies have suggested that vitamin D is involved in cardiovascular diseases and have provided evidence that it has a role in reducing cardiovascular disease risk. It may be involved in regulation of gene expression through the presence of vitamin D receptors in various cells, regulation of blood pressure (through renin-angiotensin system), and modulation of cell growth and proliferation including vascular smooth muscle cells and cardiomyocytes. Identifying correct mechanisms and relationships between vitamin D and such diseases could be important in relation to patient care and healthcare policies.     

儿童青少年肌肉质量与心血管疾病危险因素的关系

目的 探讨儿童青少年肌肉质量与心血管疾病危险因素的关系,为心血管疾病的早期预防提供理论依据。方法 采用现况研究设计,以整群抽样的方法于2017—2020年抽取宁夏银川市12~17岁儿童青少年共1 622名为研究对象。对所有参与测试者进行问卷调查、体格测量、实验室检查、体成分检查。结果 总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)与肌肉质量指数(SMMI)呈负相关(r＝-0.105,-0.094,P<0.001);甘油三酯(TG)与全身肌肉质量(SMM)呈负相关(r＝-0.067,P<0.01)。高SMMI者患高血压、高TC、高TG分别是低SMMI者的0.60(95%CI: 0.37~0.97)、0.54(95%CI: 0.33~0.89)倍和0.53(95%CI: 0.32~0.87)倍(P<0.05);SMMI良好、充足患高脂血症的风险分别是SMMI严重不足的0.32(95%CI:0.15~0.70)、0.23(95%CI: 0.08~0.65)倍(P<0.05)。SMMI良好患血脂异常的风险是SMMI严重不足的0.44(95%CI:0.22~0.89)倍(P<0.05)。结论 儿童青少年肌肉质量与心血管疾病危险因素关系密切,低肌肉质量为高血压、高脂血症的危险因素。     

Effects of vitamin D supplementation on 25-hydroxyvitamin D,high-density lipoprotein cholesterol,and other cardiovascular disease risk markers in subjects with elevated waist circumference

The objective of the present trial was to assess the effects of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] and high-density lipoprotein cholesterol (HDL-C) in subjects with high waist circumference. Subjects were randomly assigned a daily multivitamin and mineral (MVM) supplement or a MVM supplement plus vitamin D 1,200 IU/day (MVM+D) for 8 weeks. There was a significant difference in mean change for 25(OH)D between the MVM and MVM+D treatment groups ( ? 1.2 ± 2.5 nmol/l vs. 11.7 ± 3.0 nmol/l, respectively; P = 0.003). Vitamin D 1,200 IU/day did not increase 25(OH)D to a desirable level ( ≥ 75 nmol/l) in 61% of participants. There were no significant changes in cardiovascular disease risk markers. Thus, vitamin D supplementation with 1,200 IU/day was insufficient to achieve desirable serum 25(OH)D in most participants and did not affect cardiovascular disease risk markers.     

Long-term effects of nutritional group education for persons at high cardiovascular risk

BACKGROUND: Treatment of persons at high risk for coronary heart disease (CHD) should include nutritional counselling, but little is known about the effects of different types of education. METHODS: In a quasi-experimental study design the effects of a nutritional education programme (1st year: three group sessions by a dietitian; 2nd year: one group session; 3rd year: additional focus on saturated fat; reinforcement by written nutritional messages annually) (intervention group; n=103) are compared with the effects of a posted leaflet containing standard dietary guidelines (control group; n=163). Participants had hypercholesterolemia (6-8 mmol/l) and at least two other CHD risk factors. RESULTS: After 3 years, no significant differences existed in established CHD risk factors between intervention and control groups (adjusted mean net differences: total cholesterol (0 mmol/l), diastolic blood pressure (-1.1 mm Hg; NS), and body weight (+0.3 kg, NS)). Regarding dietary intake, the intervention group had a lower intake of total (net difference -2.0% of energy, SEM 0.9) and saturated fat (-1.2% of energy, SEM 0.4) and a higher fish (+11 g/day, SEM 4) and vegetables consumption (+21 g/day, SEM 10) during the study period (p<0.05 for all). CONCLUSION: A nutritional education programme with group sessions changed dietary intake more effectively than a posted leaflet, but no additional positive effects were observed on established CHD risk factors after three years of follow-up.     

Socio-economic position and coronary heart disease risk factors in children and young people. Evidence from UK epidemiological studies

BACKGROUND: Coronary heart disease (CHD) is a condition with its origin in early life. In adults, CHD and its risk factors show clear socio-economic gradients. The aim of the present review is to collate published evidence to assess if these risk factor gradients are also apparent in young people in the UK. METHODS: Pertinent publications were identified in four ways: i) a systematic search of PUBMED from its inception in January 1966 until October 2000; ii) scanning the reference sections of identified publications; iii) searching the authors' own files; and iv) contacting experts in the field. RESULTS: Of eleven CHD risk factors, consistent evidence concerning the association in child- and early adulthood with socio-economic position was evident for cigarette smoking, birth weight, adiposity (in young adults), height, and some aspects of diet, particularly fat and fibre consumption. As in UK adults, the most favourable levels of these risk factors were seen in young people from socially advantaged backgrounds. For the other variables associated with CHD--physical inactivity/low cardiorespiratory fitness, blood pressure, blood cholesterol, adiposity (in children), and some emerging risk factors (C-reactive protein, homocysteine, fibrinogen)--there was little evidence of any clear association with socio-economic level. CONCLUSIONS: While social variation is seen in some CHD risk factors in young people, further data are needed to fully explore if this is also the case for others. This issue could be addressed by analysing some existing but unutilized survey data from the UK.     

Personalized nutrition for the prevention of cardiovascular disease: a future perspective

Cardiovascular disease (CVD) is responsible for significant morbidity and mortality in the Western and developing world. This multi-factorial disease is influenced by many environmental and genetic factors. At present, public health advice involves prescribed population-based recommendations, which have been largely unsuccessful in reducing CVD risk. This is, in part, due to individual variability in response to dietary manipulations, that arises from nutrient–gene interactions (defined by the term 'nutrigenetics'). The shift towards personalized nutritional advice is a very attractive proposition, where, in principle, an individual can be given dietary advice specifically tailored to their genotype. However, the evidence-base for the impact of interactions between nutrients and fixed genetic variants on biomarkers of CVD risk is still very limited. This paper reviews the evidence for interactions between dietary fat and two common polymorphisms in the apolipoprotein E and peroxisome proliferator-activated receptor-γ genes. Although an increased understanding of how these and other genes influence response to nutrients should facilitate the progression of personalized nutrition, the ethical issues surrounding its routine use need careful consideration.     

Understanding of cardiovascular disease risk factors among Bangladeshi immigrants in New York City

Objectives: Among all South Asians, Bangladeshis have the highest prevalence of cardiovascular disease (CVD). The purpose of our study was to compare the understanding of CVD risk factors among Bangladeshi immigrants to the general Caucasian population in the U.S.

Design: We surveyed Bangladeshi immigrants in Queens, New York using a CVD risk factor knowledge instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess awareness of risk factors. Using multivariate regression modeling, we compared scores on the knowledge instrument between Bangladeshis we surveyed and Caucasians from the CARDIA study, controlling for potential confounders. We subsequently examined the frequency of mentioning each risk factor to understand what was driving the difference in the overall score.

Results: The proportion of Bangladeshis scoring low on the knowledge assessment was 0.53, where as the proportion of whites scoring low in the CARDIA study was 0.32 (p value?<?.001). Whites were 34% more likely to score high than Bangladeshis (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.19–1.52). Bangladeshis were more likely to mention diet and cholesterol as risk factors and less likely to mention lack of exercise, being overweight, and smoking as risk factors.

Conclusion: Understanding of cardiovascular disease risk factors was lower among Bangladeshis than whites. This was driven by Bangladeshis having less awareness regarding how exercise and being overweight contribute to CVD. Community based interventions and community health partnerships should target these behavioral risk factors in the Bangladeshi population.     

Smoking in young people with asthma

BACKGROUND: Modern guidelines for the management of asthma state that asthmatic patients should be strongly advised not to smoke. However, it remains unclear to what extend young people with asthma actually behave like this. This study compares the prevalence of daily smoking between 15-year adolescents with diagnosed asthma and without asthma, and evaluates to what extent risk factors for smoking play a comparable role in the smoking behaviour of these two groups. METHODS: The study is part of the 2001-2002 international HBSC study. Besides questions about health behaviour, individual and social resources, a set of asthma questions were included in six countries. RESULTS: Adolescents with diagnosed asthma are more likely to be daily smokers than non-asthmatic adolescents. In asthmatic and non-asthmatic adolescents, similar associations with risk factors are found for daily smoking (drunkenness, cannabis use, low life satisfaction, spending evenings with friends, having smoking parents and peers). Diagnosed asthmatics are more prone to score high on these factors than non-asthmatics. CONCLUSIONS: Smoking in adolescents with asthma is a public health problem. Smoking prevention efforts directed towards young people should pay attention to young people with asthma and the curative sector should increase their efforts to motivate asthmatic adolescents not to smoke.     

Tobacco use by early adolescents in Norway.

BACKGROUND: This study examined trends in the prevalence of smoking and snuff use among Norwegian adolescents in lower secondary school (ages 13-15 years) from a national survey conducted every 5 years between 1975 and 1995. METHODS: Pupils completed a brief written questionnaire on tobacco use and related information. Local school administrators coordinated data collection and forwarded a sample of completed questionnaires to the National Council on Tobacco and Health for compilation and analysis. Effects for age, gender and survey year were examined using logistic regression analysis. Overall, 24,127 pupils in five different cohorts were included. RESULTS: Smoking was highest in 1975 when 45.5% of youth reported smoking either daily or occasionally (figures adjusted for age and gender). Smoking declined each year thereafter through to 1990 (23.6%) but increased in 1995 (26.0%), primarily due to an increase in occasional smoking. Like smoking, snuff use declined between 1985 and 1990 but increased in 1995. All changes across survey years were statistically significant. Smoking was higher among girls than boys, while snuff use was much higher among boys. CONCLUSION: Several hypotheses that might account for the recent increase were examined with the most likely factor being Norway's low allocation of resources for educational interventions and public information campaigns during the years studied. However, in the past 2 years Norway has undertaken a number of new tobacco control initiatives that may result in reversal of the most recent trends.     

硒与心血管疾病的研究进展

硒是生物体内一种重要的微量元素,在体内具有抗氧化、促进免疫、清除自由基等功能,对维持人体正常生理功能起着关键作用。缺硒与克山病、冠心病、动脉粥样硬化、心肌炎等心血管疾病的发生、发展及治疗有着密切的关系。     

Process evaluation of a multifaceted intervention to improve cardiovascular disease prevention in general practice

Objectives: To perform a process evaluation of a multifaceted intervention to improve cardiovascular and diabetes care in general practice.

Methods: The feasibility of the intervention, carried out by outreach visitors in 62 practices, was addressed by evaluating whether the intervention programme was performed as planned and the extent to which it was accepted by the practice team. In addition, the costs of the programme were determined.

Results: The intervention was largely carried out as planned, although the intervention period had to be extended by three months. Of the 18 topics that could be addressed during the intervention period, 12 (mean) were addressed. The number of outreach visits per practice was 15.2 (mean), each visit lasted about one hour. Most practice members endorsed both the key recommendations for clinical decision-making and car — diovascular risk profiling.

The majority of GPs (range 63-98%) agreed with the guidelines for clinical decision-making, and 29-97% had a positive opinion about the guidelines for practice organisation. According to practice staff members, the outreach visitor had sufficient knowledge and skills to support them in changing the practice organisation.

GPs were less positive about the outreach visitor's knowledge and skills in optimising clinical decision — making; however 78% believed that the outreach visitor contributed to effecting change in their clinical decision-making. The total costs of the intervention per practice were 4317.

Conclusions: This process evaluation demonstrated that the intervention was usually carried out as planned and achieved a high satisfaction rating from the participating practice members.